Black Friday Wishlist

Black Friday is this week. I have never been one to get up super early to stand in line, but you all know I am a sucker for a good deal! I decided to do a little research before Black Friday to scope out some of my favorite retailers to make a wish list for…

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Arugula Breakfast Sandwich with Caramelized Onions

Start the morning off right with this Arugula Breakfast Sandwich with Caramelized Onions! This breakfast sandwich is a simple breakfast made with a whole grain English muffin, peppery arugula, and delicious caramelized onions that leave you with a full belly until lunch!  Happy Friday, friends! Lee and I are currently in Chicago for a weekend full of fun…

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The Great American Hypertension Epidemic

On November 15, 2017, an epidemic of hypertension broke out and could rapidly affect tens of millions of Americans.  The epicenter of the outbreak was traced back to the meeting of the American Heart Association in Anaheim, CA.

The pathogen was released in a special 488-page document labeled “Hypertension Guidelines.”  The document’s suspicious content was apparently noted by meeting personnel, but initial attempts to contain it with an embargo failed and the virus was leaked to the press.  Within minutes, the entire healthcare ecosystem was contaminated.

At this point, strong measures are necessary to stem the epidemic.  Everyone is advised not to click on any document or any link connected to this virus.  Instead, we are offering the following code that will serve both as a decoy and as an antidote for the virulent trojan horse.

Only a strong dose of common sense packed in a few lines of text can possibly save us from an otherwise lethal epidemic of nonsense.  Please save the following text on your EHR cloud or hard-drive, commit it to memory or to a dot phrase, and copy and paste it on all relevant quality and pay-for-performance reports you are asked to submit.

PREAMBLE:

  1. The blood pressure is a physiologic quantity necessary for, and indicative of, human life.
  2. The blood pressure normally fluctuates for moment to moment. The range of values encompassed by the blood pressure is wide and depends on personal characteristics, as well as circumstances.  For example, during sleep, invasively measured systolic blood pressure in healthy individuals may fall to 70 mmHg or even lower.  During weightlifting, the systolic blood pressure may rise as high as 480/350 mmHg.
  3. Pitfalls that can potentially limit the accuracy of the measurement of blood pressure are many.
  4. The so-called “resting” blood pressure measured in asymptomatic individuals has statistical significance regarding the long-term health of the individual: the resting blood pressure relates to a risk of adverse health outcomes.  That risk is estimated by large scale clinical studies and is modified by patient circumstances.
  5. The statistical relationship between the resting blood pressure and health is J-shaped.

  1. Because the relationship between blood pressure height and outcomes is statistical, the nadir of the J-shaped curve cannot be determined on an individual basis.
  2. Because the nadir of the curve cannot be determined on an individual basis, and because the relationship between the blood pressure height and risk is continuous and gradual, no specific blood pressure value or range of values can segregate “normal” from “abnormal” blood pressure.
  3. In the 1950s Sir George Pickering described any selection of normal values as “the fallacy of the dividing line.”  It was a fallacy then, it remains a fallacy now.

HYPERTENSION GUIDELINE:

  1. Doctors are called to act prudently and to take into account individual patient circumstances that may impact on diagnosis and treatment (Recommendation Class: I; Level of Evidence: C).
  2. The guideline for the treatment of high blood pressure is to understand the above graph (Recommendation Class: I; Level of Evidence: C).

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What Baseball Can Teach Doctors

Baseball, like medicine, is deeply imbued with a sense of tradition, and no team more so than the New York Yankees, disdainful of innovations like placing players’ names on the backs of their jerseys and resistant to eroding strict standards related to haircuts and beards.

It’s why doctors and patients alike should pay special attention to why the Yankees parted ways with their old manager and what they now seek instead. In a word: “collaboration.”

That’s the takeaway from a recent New York Times article examining why the Yankees declined to re-sign manager Joe Girardi despite his stellar “outcomes” (to use a medical term); i.e., the best record in baseball during his 10 years at the Yankees’ helm. But Yankees executives believe the game has changed. The model for future success is the Los Angeles Dodgers, the tradition- and cash-rich franchise on the opposite coast that went to this year’s World Series while the Yankees sat home.

The new way to win? According to Dodgers executives, it requires a combination of statistical analysis, shared decisions and communication between and among all stakeholders based on collaborative relationships.

Look at that: evidence, shared decision making and communication! It’s participatory medicine in pinstripes!

Beyond a reverence for tradition, the parallels between baseball and medicine are… striking. Doctors manage individual patients, and baseball, while a team sport, is very focused on individual match-ups. As in medicine, managerial decisions have traditionally been driven as much by heuristics (“That’s the way it’s done”) as by data.

However, just as evidence-based medicine has spotlighted the dubious basis of long-accepted medical practices such as “Once a C-section, always a C-section,” the rise of sabermetrics, famously chronicled in Moneyball, has exposed faulty baseball bromides related to practices such as when to sacrifice bunt or lefty/righty matchups.

While baseball players are employees and patients aren’t, managerial dictates with which players disagree can affect their performance (just as patients can be “non-adherent”) and, ultimately, the outcome of the game. Moreover, just as the primacy of the doctor’s authority with non-physician colleagues has changed, so, too, has the baseball manager’s. In both cases, information access is breaking down established hierarchies. As the Times put it:

With statistical analysis and sports science playing a more prominent role in how lineups are constructed and the bench is deployed each day, the modern manager must be able to communicate these new strategies — particularly with younger players who may wonder why they are not playing.Relationships are the foundation for those dialogues…. Communication is not strictly top down. Decisions that were once the domain of a manager are now collaborative, involving the front office, pro scouts, player development and sports science staff members, among others….[S]aid Farhan Zaidi, the Dodgers’ general manager…”It’s not about pointing the finger at one person who goes into an office and locks the door and makes the decision by himself. The process is a lot more organic than that, and I think that’s the way the game is headed.”

The problem with the veteran Girardi, Yankees general manager Brian Cashman eventually acknowledged, was not his baseball knowledge but “the ability to fully engage, communicate and connect with the playing personnel.”

We do not yet recruit neurosurgeons based upon Wins Above Replacement (though the equivalent statistic is certainly coming), nor offload orthopedists for an arrogant attitude. However, Major League Baseball’s entire 2017 payroll of $4 billion wouldn’t pay for even a half-day’s worth of the $3.5 trillion spent annually on U.S. health care. With an estimated 30 percent of that massive amount going to waste, the pressure on every player in the system to “win” with patients will make Game 7 of the World Series look like a pickup softball match at a summer picnic.

Yes, “gut instincts,” knowledge and experience still count. Nonetheless, there is an intensifying emphasis on combining those attributes with both data expertise and a knowledge of how to build the right relationships, whether in baseball and other sports or in education, policing and throughout our economy. In a recent article for the BMJ on collaborative health, I urged physicians to stop bemoaning their inevitable loss of control and instead reach out to patients with shared information, such as opening up the complete electronic medical record; shared engagement, including with non-traditional actors such as online communities; and shared accountability.

Like ballplayers and managers, patients and doctors share a common goal, albeit with a much more serious win-loss column than the one involving what are after all, only games. As with ballplayers, the best outcome may sometimes depend on patients doing what they’re told, quickly, competently and without dispute. But for that to happen, the process of mutual engagement, communication and connection must happen first. Sometimes, the manager has to be the one who listens.

The Yankees have not stopped nixing names on uniforms nor suddenly become forgiving about facial hair. But even baseball traditionalists are realizing that dugout instincts and sabermetric savvy aren’t enough if a manager whiffs on building the right relationships. The player “experience” isn’t an add-on; you can’t be competitive without collaboration.

Soon enough, physicians and others will realize that the same formula for success holds true in health care.

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The New Health Care Experience For Consumers

By HEALTH 2.o                                     SPONSORED CONTENT
We are human and we need health care. These are universal truths. Here’s another one – we are consumers. Consumers who happen to be in a constant state of adapting to new health care protocols. The advent of value-based care over fee-for-service has also seen an emergence of empowered consumers who are not only informed but savvy in their health care decision making. Where do I purchase? From who? How much does it cost? How much can I afford? When do I purchase? What if I need a specialist? The list goes on. Luckily there is an ever-growing group of people and organizations who continue to make the consumer experience streamlined, affordable, and personal. Even in the gravest of scenarios.

Cambia Health Solutions, based in Portland, OR, is one such organization. They are affectionately referred to as “the-100-year-old startup” which is as much a testimony to their legacy as it is their bold insistence on moving the needle. What Cambia does perhaps better than most is Palliative Care. In 2014 they launched their greatest initiative to date – a program that serves patients living with serious illnesses in a new way. Cambia’s approach is to prioritize the person, as well as the experience of their families. Their revised care plans often include a collaboration with the family and reflect physical needs as well as the social and the spiritual.
With over 31 million in financial support from their Foundation, Cambia has been able to create and grow what they call “a shared network of competency” which includes interdisciplinary care teams across hospitals, providers, and regions. And it’s working. Cambia’s Palliative Care program has seen such wild success in Portland, OR that they have expanded across the Northwest and to Utah, Idaho, and into California.
Leading Cambia’s audacious model of radical empathy and exceptional transparency since 2003 is Mark Ganz. He is the son of a doctor and has dedicated his career to the transformation of health care by putting people first. His upbringing as an Eagle Scout taught him to ‘leave your campsite better than you found it’ – an ethos he infuses across all of Cambia’s projects.
Ganz will be headlining Health 2.0’s Annual WinterTech event during JP Morgan week on January 10 in  San Francisco. His presentation will cover how to create seamless health care experiences to meet the needs of consumers, and provide a contextualization for a day’s worth of programming dedicated to the empowered consumer as well as investing and digital therapeutics.
Register for WinterTech today!

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Streamlining Telemedicine Rules a Key to Improving Healthcare Services

U.S. healthcare is immersed in a digital age where patients armed with smartphones and wearables are the consumers and efficiency is both a service and a commodity.

As access to technology expands, payers and providers alike are turning to telemedicine as a cost-effective means of delivering quality care. Patients can connect with specialists in an instant, and providers in different locations can confer on care plans in real time, improving the patient experience while reducing costs.

Standing in the path of widespread telemedicine adoption is a patchwork of state laws that dictate how services delivered via telemedicine are reimbursed. States with full or robust telemedicine parity have regulations in place that require coverage and reimbursement be comparable to in-person services.

Some states are more advanced than others. Mississippi, for example, perennially scores low on most quality care surveys, yet it is one of the most ardent supporters of telemedicine capabilities. Meanwhile, Massachusetts, a state generally known for innovative healthcare programs, ranks poorly in telemedicine due to a lack of private payer parity regulations.

While all states have some form of Medicaid telemedicine coverage, the level of parity differs when it comes to factors such as types of technologies, patient settings and tertiary care. Rules around telemedicine coverage and reimbursement vary even more widely among states when it comes to commercial payers.

Decision Resources Group tracks telemedicine parity and offers an analysis of commercial payer telemedicine parity performance by state. In addition, several states have legislation pending that would better recognize telemedicine services, and many are also making improvements to parity under their Medicaid programs.

Despite some obstacles and hiccups, telemedicine is a rapidly growing industry. The global market is expected to reach $38 billion by the year 2022. This statistic alone should provide ample incentive for the key players to make sure telemedicine reimbursement is easily attainable while restrictions are greatly minimized.

Chris Silva is a senior analyst at DRG and specializes in information technology, telehealth and big data, among other topics. Follow him on Twitter at @ChrisSilvaDRG

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On THCB

a href=”http://ift.tt/2mrREWm; rel=”bookmark”>Why You Should Read Books By Nicholas Nassim Taleb
By SAURABH JHA, MD

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